Key point: the fact that a medical problem was diagnosed after an accident is not, by itself, sufficient to prove that the accident caused it.

01 / Definition

What causation means.

In medico-legal terms, causation is the relationship between a traumatic event and the anatomical or functional change being assessed.

The principal question is not merely “what diagnosis does the person have?”, but whether the medical evidence allows the injury or consequence to be attributed to the event.

The answer must correlate all available information. Neither a single document nor the statement that symptoms began after the accident is sufficient.

For vehicle accidents, the method approved by ASF/Ministry of Health Order no. 1/2,293/2022 requires identification of injuries and consequences causally related to the accident.

02 / Boundaries

Medical causation is not
legal liability.

The medical assessor considers the relationship between trauma and its health consequences. The assessor does not determine:

  • who was at fault for the accident;
  • whether a person is civilly or criminally liable;
  • the legality of the participants' conduct;
  • the final amount of compensation;
  • the outcome of litigation.

The medico-legal conclusion may be important medical evidence, but it does not replace legal assessment of the case as a whole.

03 / Method

Main elements assessed.

  1. 1

    Chronological sequence

    The injury or symptoms should appear within a period compatible with the event. Temporal proximity matters but does not prove causation on its own.

  2. 2

    Compatibility of mechanism

    Type, direction and intensity of impact, body region, the person's position and protective equipment should be capable of explaining the injury.

  3. 3

    Anatomical consistency

    Injury location is correlated with the exposed region, taking account of transmitted forces and possible indirect injury.

  4. 4

    Continuity of documentation

    Initial examination, investigations, diagnoses, treatment, rehabilitation and complications should allow medical progress to be reconstructed.

  5. 5

    Medical plausibility

    The reported course must be compatible with medical knowledge about the injury and the period in which its consequences may arise.

  6. 6

    Alternative causes

    Pre-existing disease, earlier or later trauma, degenerative changes and other disorders capable of explaining the findings must be considered.

04 / Medical context

The role of pre-existing conditions.

A prior disease does not automatically exclude a relationship between the accident and the consequence. Trauma may cause a new injury, aggravate a disorder, make a previously asymptomatic change symptomatic or interact with the natural course of disease.

To the extent permitted by the evidence, the assessment should distinguish:
  • a new injury caused by trauma;
  • aggravation of a pre-existing condition;
  • the natural course of prior pathology;
  • the combined contribution of trauma and prior health.

Degenerative imaging findings do not automatically prove that all symptoms existed before the accident. Conversely, symptoms beginning afterwards do not turn every pre-existing change into a traumatic injury. See the guide to pre-existing injuries and road accidents.

05 / Evidential limitations

What may weaken proof
of causation.

  • delayed medical presentation;
  • missing records from the time of the accident;
  • diagnoses based only on the person's account;
  • inconsistencies between records;
  • missing necessary investigations;
  • a prolonged gap in follow-up;
  • a second traumatic event;
  • symptoms without clinical or investigation correlates;
  • inability to determine the prior condition.

These factors do not necessarily exclude causation, but they should be explained and reflected in the degree of certainty of the conclusion.

Simplified example

A fracture found immediately after impact in the affected region has a coherent documentary sequence. Pain first reported months later, without an initially documented injury and with only degenerative changes, requires broader analysis and does not allow automatic attribution.

06 / Trauma score

Causation and
the REMA report.

A REMA report should not automatically score every diagnosis in the medical file. For each item, it is necessary to verify that the injury is documented and attributable to the accident, that a complication derives from it and that a permanent consequence is objectively demonstrated.

  • confirm that the injury exists and is documented;
  • determine its relationship with the accident;
  • consider alternative explanations;
  • verify classification under the applicable scale;
  • give reasons for including it in the score.

See also How is the trauma score calculated?

07 / Documentation

Important documents.

  • records prepared immediately after the event;
  • prehospital and emergency department records;
  • hospital notes and discharge summary;
  • imaging reports and original images where relevant;
  • operative reports and specialist consultations;
  • treatment and rehabilitation records;
  • existing medico-legal documents;
  • medical records predating the accident;
  • information about any later traumatic events.

If the records are insufficient or incomplete in relation to the person's condition, the REMA method allows additional documentation or examinations to be requested, with the assessed person's explicit consent.

08 / Frequently asked questions

Important clarifications.

Is it enough that symptoms appeared after the accident?+

No. Temporal sequence is important, but it must be correlated with mechanism, objective findings, records and clinical progress.

Does a pre-existing disease exclude causation?+

Not automatically. Trauma may cause a new injury, aggravate an existing disorder or render a pre-existing change symptomatic. The contribution of each element must be assessed individually.

Does delayed presentation to a doctor exclude an injury?+

Not in every case, but it makes chronology and attribution more difficult to demonstrate. The reason for the delay and subsequent records become important.

Can the same consequence have several causes?+

Yes. The medical outcome may be influenced by trauma, prior health, treatment and complications. The assessment should describe that interaction without unjustified simplification.

Does a medico-legal report determine fault?+

No. It analyses medical issues and the causal relationship between trauma and consequences. Fault and liability are legal questions.

09 / Sources

Framework consulted.

  1. ASF/Ministry of Health Order no. 1/2,293/2022 — Romanian Legislative Portal
  2. Official trauma score schedule — Romanian Legislative Portal
  3. Procedural rules for medico-legal work — Romanian Legislative Portal

This information is general. Applying it to an individual requires examination of the documents, mechanism and medical condition.